Medical Volunteer Information

How many weeks per year are you available to go on B&L missions?*
  • One week
  • Two weeks
  • One month
  • Three months
  • Other
What geographic regions are you interested in?*
  • North America
  • Central America
  • South America
  • Micronesia
  • Philippines
  • Vietnam
  • Asia
  • India
  • Eastern Europe
  • South Africa
  • Africa
What languages besides English do you speak conversationally?
What areas of Blade and Light Missions are you interested in?*
  • Mohs Surgery and Reconstruction
  • Scar Revision
  • Lasers for Birthmarks or other disfiguring conditions
  • Needs assessments and preventative skin cancer care
  • Organizing Blade and Light Missions
  • Organizing Blade and Light Fundraisers
  • Working on the Blade and Light Website
  • Coordinating a Blade and Light Clinic

Contact Information

Title
First Name*
Middle Name
Last Name*
Country
Address
City
Postal Code
Email*
Confirm Email*
Phone*
Gender*
Date of Birth*
State Medical License Number*
Medical Specialty*
Board Certified*
Board Eligible*
Current Position*
Additional Comments

Security Code